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Breastfeeding Failure, Or Medical Community Fail?

A lack of research, lack of funding, and lack of concern for issues affecting women and children mean more women are steered toward formula than otherwise would be if doctors better understood breastfeeding, and could better address individual moms’ difficulties from the get-go. The good news? This is beginning to change.

Colleen Kelly, a mom whose infant daughter was diagnosed as failure to thrive when Kelly was unable to produce enough breast milk to sustain her, quickly realized – after her baby underwent tests that showed nothing to be amiss in the baby -- that "none of the doctors or nurses knew enough about breast-feeding to figure out what was happening.” Kelly’s own mother had experienced the same supply problems as she was experiencing now, but doctor’s dismissed this family history, and Kelly ended up feeding her baby formula. She’d wanted to breastfeed, but, apparently, couldn’t.

There is a widespread belief in both the pro-breastfeeding communities (which are often anti-formula) and the medical community (which has long promoted formula to moms as an A-okay convenience or choice, but rarely a medical necessity) that all women can breast feed… if they want to. But lactation consultants are trained in helping babies and moms get the hang of latching, and comfortable positions, and doctors – as this recent TIME article’s author points out – are barely trained in the physical aspect of breastfeeding at all. While they may know about the basic benefits of breast milk for babies – which are numerous – and that formula is a good backup option for those who choose that route, actual anatomical barriers to breastfeeding, in moms, are not familiar territory for most lactation consulatants or doctors, at all. As a result, moms who want to breastfeed but who experience serious supply issues end up feeling like failures, rather than finding the help they need.

As the TIME article elucidates, “When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. ‘We just give women a pat on the head and tell them their kids will be fine,’ if they don't breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. ‘Can you imagine if we did that to men with erectile dysfunction?’”

In fact, “Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure.” Lactation dysfunction isn’t even ‘real’ in medical diagnosis parlance, so doctors attempting to address it come up against a wall when it comes to billing insurance companies for their time and any relevant testing. That formula companies have long provided financial incentives to hospitals for providing their product to new moms doesn’t solve the problem, either; it provides a quick and easy (especially for busy hospital staffs) band-aid solution to moms’ lactation problems, and further discourages real research into ways to help these moms breastfeed, if that’s what they want to do. As more hospitals sever their corporate formula-brand ties, however, and dub themselves ‘baby friendly’, the need for a deeper understanding of what makes breastfeeding work is going to be crucial. The up-side of this piece is that more research is beginning to take place in this sphere. And, the Affordable Health Care Act advises that health insurance companies should provide "comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment." (Effective August first.) In other words, women and babies are finally getting some systemic support.

Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, California, cites health problems such as hypoplasia, thyroid problems, hormonal imbalances and insufficient glandular tissue as contributing to “as many as 5%” of women having a significantly hindered ability to breastfeed. Honestly, although it may refer to the more serious medical conditions on the supply (or anatomical) problems spectrum, this number strikes me as really low. Two-thirds of American moms don’t meet their breastfeeding goals; lack of medical and cultural support are largely to blame, and the two are intertwined. A lack of medical understanding – much of which stems from a lack of research, lack of funding, and lack of concern for issues affecting women and children (see above re: the erectile dysfunction research comparison) – means more women are steered toward formula than otherwise would be if doctors better understood breastfeeding, and could better address individual moms’ difficulties from the get-go. And a lack of cultural support – from super-short maternity leaves to workplace (or public space) hostility toward breastfeeding moms – can likewise create supply issues, for which moms can find few solutions beyond formula.

One additional problem is that there’s some confusion about where these moms should turn for the help they need: “Doctors practicing today don't know where to place breast-feeding problems --breasts are attached to the women, so shouldn't they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn't the baby's doctor handle it?” The emerging answer here is that any of these doctors with a sub-specialty in breastfeeding medicine would be qualified as a Breasfeeding Doctor, available to help women and their babies – because real-life family members do not fall so cleanly into separate healthcare categories – breastfeed successfully.

Last year, the AAP released new breastfeeding guidelines, urging women to breastfeed exclusively for six months, citing the scientific research supporting the suggestion and calling upon hospitals, pediatricians, workplaces and society-at-large as responsible for American moms’ breastfeeding success. As hospitals have followed suit, the picture has broadened to reveal the ways in which our medical system – right down to the research that gets funded and the knowledge doctors are equipped with – has failed to really address the complexities of breastfeeding problems, and to find solutions beyond formula for new moms.

Although some opponents to ‘baby friendly’ hospital initiatives have spoken out against new breastfeeding-friendly policies -- like those in certain New York City hospitals where a medical reason must be cited before formula is given to babies -- these new policies may well be a driving force behind a better medical understanding of breastfeeding, and more solutions and support for moms. At the very least, more research will need to take place in order to create a basic medical terminology for breastfeeding problems. (Otherwise, what will medical professionals write on those formula release forms?) A diagnostic terminology will result in the ‘official’ recognition of breastfeeding as a topic within the medical field. And this recognition will lead to moms being taken seriously when they turn to their doctors for breastfeeding help. It’s about time we received something better than 'a pat on the head’ in response to our inquiries into our own bodies and well-being. New policies, more research, and a mom-friendly healthcare system – from hospitals to the insurance insurance billing breakdown – need to step up to the plate, and it looks like they may be beginning to do so now.

PS. (Pssst!) There’s a giveaway happening on my other blog, Alt-Mama, right now; head on over and enter to win!